Last reviewed 17 September 2018
In this feature, Thoreya Swage, Healthcare Consultant, explains the process for developing the 10-year NHS Plan.
In June 2018, the then Secretary of State for Health and Social Care, Jeremy Hunt, secured extra funding as a 70th birthday present for the NHS in England. This funding (£20 billion) is to cover the next five years. In return, the NHS was asked to develop a plan for the health service to cover the next 10 years. The plan was to be developed from the bottom upwards with wide consultation including the involvement of patients and the public, be “clinically-led” and to be ready for November 2018. This article describes the latest progress in the development of the plan.
There is an expectation that the plan would be simple in its ambitions such that the tasks identified are deliverable and continue on a course of integration. Annual milestones, such as development of patient records or reduction in trust/CCG deficits will be sought to demonstrate progress. The NHS is also encouraged to make suggestions as to how the legislation could be changed to permit continued development of services, eg through the development of integrated care systems.
What are the overall priorities?
When announcing the extra funding, the Prime Minister identified the following priorities to be covered in the plan.
Delivering the performance standards, ie the A&E, cancer and referral to treatment (RTT) waiting times.
Securing the progress made in the quality and safety of care.
Improving cancer care outcomes so that they are the best in Europe.
Ensuring parity of esteem between physical and mental health through better access to mental health services.
Enhancing integration between health and social care ensuring that patients do not lose out when transferring across the different systems.
A renewed focus on helping people to have longer and healthier lives through the prevention of ill health.
In addition, five financial tests were set for the NHS to demonstrate how it would be put onto a more sustainable footing. These include:
enhancing productivity and efficiency
provider deficits to be eliminated
reducing variation in the system so that consistently high standards are delivered wherever people live
better management of demand for services
better utilisation of investment in capital.
How is the plan being developed?
There is an expectation that as many stakeholders as possible have an opportunity to have their say on the content of the 10-year NHS Plan so that they are able to shape the future of general practice, mental health services and acute care in England.
What are the areas to be covered within the plan?
The settlement covers NHS care only. In early August, a briefing from NHS England’s Long Term Plan Engagement Team was published, which detailed the different working groups that have been set up to address specific areas. The working groups comprise local and national system leaders, partners and stakeholders, who have been brought together to inform the final plan.
There are three working groups which cover:
Key questions/issues concerning the topic
Life course programmes
Health prevention and inequalities and personal responsibility
Children and maternal health
Personalised and integrated care for people with long-term conditions and frail older people (including dementia)
Learning disability and autism
Cardiovascular and respiratory conditions
Workforce, leadership and training
Research and innovation
Engagement of stakeholders, including patients
In addition, there are also three overall questions which have been posed covering:
identifying the core values to underpin the long-term plan for the NHS
local examples of better ways of working or good services that should be replicated across the country
barriers to improving care and health outcomes for patients receiving NHS services.
How will these working groups operate?
A key aspect of the development of the 10-year plan is ensuring that the advice and experience of experts both clinical and other stakeholders, which must include patient and public representatives, is incorporated.
Securing the engagement of all these stakeholders is necessary and will be running through the three phases of development.
Seeking advice from key stakeholders — this would include meetings with the leaders of key stakeholders in order to elicit initial opinions and continued input to the process.
Continued engagement of stakeholders — this would involve the co-development, refinement and testing of proposals for the plan.
Engagement with staff on the frontline, patients and the public through the networks associated with NHS organisations/systems and stakeholders. This is to obtain wider views and confirm priorities for the plan.
There will also be some work on creating an “NHS Assembly” comprising representatives of staff from the NHS and patients, the role of which will be to oversee the implementation of the plan.
What is the timeline for this work?
The Government has indicated that the plan should be submitted by mid-November 2018 in time for the Autumn Budget. This means that there are three months in which to do the following.
In parallel with this process, NHS England has just finished a consultation on two areas of primary care which will feed into the NHS Plan as well as informing the discussions on next year’s GP contract negotiations. They are a review on the Quality and Outcomes Framework and the effect of digital technology on general practice payments. The latter seeks view on payment reform to reflect emerging digital models of primary care without destabilising existing services.
The deadline for responses to these questions posed by the working groups is 30 September 2018.
What is not covered by the NHS Plan?
The NHS Plan does not cover Social Care or Public Health that both come under the remit of local authorities. However, an Adult Social Care Green Paper is planned to be published in the autumn of 2018 which is expected to identify options for system reforms and funding options.
Issues that have been raised by the NHS
There is no doubt that the priorities set by the Government for the 10-year plan are ambitious and some concerns have been raised by the NHS in response.
There is a clear steer from the centre to produce a plan that will be transformative with the delivery of healthcare to be not only efficient but also with a greater reliance on digital technologies. While the vision is right for the future, the NHS still has to grapple with the day-to-day demands of delivering care today. For the plan to be successful, there needs to be a balance between directing resources to future developments and current service delivery.
There is also a need to balance the number of priorities that may come out of each workstream through the plan development process so that overall there is collective agreement on the delivery of the overall priorities.
The plan is being developed in isolation of Social Care and some aspects of Public Health as the budgets for these areas sit outside of the settlement for the NHS that was announced in June.